Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
INNKOMST-CTG. En vurdering av testens prediktive verdier, reliabilitet og effekt: Betydning for jordmødre i deres daglige arbeid
Nordic Council of Ministers, Nordic School of Public Health NHV.
2006 (Norwegian)Doctoral thesis, comprehensive summary (Other academic)
Place, publisher, year, edition, pages
Göteborg: Nordic School of Public Health NHV Göteborg, Sweden , 2006. , 93 p.
Series
NHV Reports and Doctor of Public Health-Theses, ISSN 0283-1961 ; Report 2006:3
Keyword [en]
Cardiotocography, Labour, Admission Test, Screening, Inter-Observer Agreement, Systematic review, Midwifery Practice
Keyword [no]
Kardiotokografi, Inkomst-CTG, Screening, Prediktive Verdier, Inter-Observatør Enighet, Kappa, Jordemorpraksis
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:norden:org:diva-3393ISBN: 91-7997-149-0 (print)OAI: oai:DiVA.org:norden-3393DiVA: diva2:748014
Public defence
2006-12-19, Nordic School of Public Health NHV, Göteborg, Sweden, 13:00 (Norwegian)
Opponent
Supervisors
Available from: 2014-09-18 Created: 2014-09-18 Last updated: 2014-09-18Bibliographically approved
List of papers
1. Norwegian midwives' perception of the labour admission test.
Open this publication in new window or tab >>Norwegian midwives' perception of the labour admission test.
2007 (English)In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 23, no 1, 48-58 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To explore what information and knowledge the labour admission test is perceived to provide and what meaning the test carries in the daily work of practising midwives.

DESIGN: In-depth interviews transcribed verbatim and analysed using the grounded theory technique.

SETTING: Four different labour wards in Norway.

PARTICIPANTS: A theoretical sample of 12 practising midwives.

FINDINGS: The core category "experiencing contradictions" was identified during the analyses, indicating that the midwives found conflicting interests within themselves, or between themselves and others when using the labour admission test. They experienced contradictions between professional identity and the increasing use of technology, between feeling safe and feeling unsafe and between having power and being powerless.

KEY CONCLUSIONS: The labour admission traces could be difficult to interpret, especially for newly qualified midwives. Some midwives thought that a labour admission trace could protect them in case of litigation. The hierarchy of power in the labour ward influences the use and interpretation of the labour admission test. Some midwives felt their professional identity threatened and that midwives in general are losing their traditional skills because of the increasing use of obstetric technology.

IMPLICATIONS FOR PRACTICE: The findings of the present study should be taken into consideration when changing practice to not routinely perform the labour admission test. There is also a need for further research on what effect the increasing use of obstetric technology has on traditional midwifery skills.

Keyword
Cardiotocography, Labour Admission Test, Midwifery Practice
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:norden:org:diva-3392 (URN)10.1016/j.midw.2005.10.003 (DOI)16876922 (PubMedID)
Available from: 2014-09-17 Created: 2014-09-17 Last updated: 2017-12-05Bibliographically approved
2. Interobserver agreements in assessing 549 labor admission tests after a standardized training program.
Open this publication in new window or tab >>Interobserver agreements in assessing 549 labor admission tests after a standardized training program.
2005 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 84, no 11, 1087-92 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The labor admission test is a short cardiotocography (CTG) performed upon admission to the maternity ward. The aim of the present study is to examine interobserver agreements when the labor admission tests were assessed by midwives and obstetricians who had received training in interpreting CTG.

METHODS: Five hundred forty-nine high- and low-risk women who delivered at Hammer-fest Hospital were included. The tests were assessed by three midwives and three obstetricians who had completed a standardized training program. The traces were assessed as normal, intermediary, or abnormal. Weighted kappa (kappaw), proportion of agreement (Pa), and predictive values were calculated.

RESULTS: Between the pairs of observers, kappaw varied between 0.57 and 0.75; Pa for a normal test between 0.78 and 0.88, and Pa for an intermediary/abnormal test between 0.56 and 0.69. At a cutoff intermediary test, mean sensitivity was 0.43 (range=0.39 -- 0.48), specificity 0.75 (range=0.69 - 0.81, positive predictive value 0.13 (range=0.12 -- 0.15), negative predictive value 0.94 (range=0.94 -- 0.94), likelihood ratio (LR) for a positive test result 1.73 (range=1.53--1.99), and LR for a negative test result 0.76 (range=0.75--0.77).

CONCLUSIONS: Midwives and obstetricians who had completed the training program achieved good levels of agreements in assessing labor admission tests. The agreements in normal tests were better than those in intermediary/abnormal tests. Obstetric staff should be aware that there are disagreements in assessing labor admission tests; especially in tests assessed as intermediary/abnormal.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:norden:org:diva-3390 (URN)10.1111/j.0001-6349.2005.00837.x (DOI)16232177 (PubMedID)
Available from: 2014-09-17 Created: 2014-09-17 Last updated: 2017-12-05Bibliographically approved
3. Prognostic value of the labour admission test and its effectiveness compared with auscultation only: a systematic review.
Open this publication in new window or tab >>Prognostic value of the labour admission test and its effectiveness compared with auscultation only: a systematic review.
2005 (English)In: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 112, no 12, 1595-604 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To assess the effectiveness of the labour admission test in preventing adverse outcomes, compared with auscultation only, and to assess the test's prognostic value in predicting adverse outcomes.

DESIGN: Systematic review.

SETTING: Labour wards in hospitals.

POPULATION: Pregnant women in labour. Three randomised controlled trials including 11,259 women and 11 observational studies including 5831 women.

METHODS: Literature searches in Medline, EMBASE, CINAHL, SweMed, The Cochrane Central Register of Controlled Trials, reference lists from identified studies and contact with experts.

MAIN OUTCOME MEASURES: Obstetric interventions (augmentation of labour, continuous electronic fetal monitoring, epidural analgesia, fetal blood sampling and operative deliveries) and neonatal outcomes (perinatal mortality, Apgar score, seizures, resuscitation and admission to neonatal unit).

RESULTS: Meta-analyses of the controlled trials found that women randomised to the labour admission test were more likely to have minor obstetric interventions like epidural analgesia [relative risk (RR) 1.2, 95% confidence interval (95% CI) 1.1-1.4], continuous electronic fetal monitoring (RR 1.3, 95% CI 1.2-1.5) and fetal blood sampling (RR 1.3, 95% CI 1.1-1.5) compared with women randomised to auscultation on admission. There were no significant differences in any of the other outcomes. From the observational studies, prognostic value for various outcomes was found to be generally poor. Likelihood ratio (LR) for a positive test was above 10 in 2 of 28 single outcomes and between 5 and 10 in six outcomes.

CONCLUSIONS: There is no evidence supporting that the labour admission test is beneficial in low risk women.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:norden:org:diva-3391 (URN)10.1111/j.1471-0528.2005.00766.x (DOI)16305561 (PubMedID)
Available from: 2014-09-17 Created: 2014-09-17 Last updated: 2017-12-05Bibliographically approved
4. Inter-observer variation in assessment of 845 labour admission tests: comparison between midwives and obstetricians in the clinical setting and two experts.
Open this publication in new window or tab >>Inter-observer variation in assessment of 845 labour admission tests: comparison between midwives and obstetricians in the clinical setting and two experts.
2003 (English)In: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 110, no 1, 1-5 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To assess the inter-observer agreement in assessment of the labour admission test between midwives and obstetricians in the clinical setting and two experts in the non-clinical setting, the inter-observer agreement between two experts in the non-clinical setting and to what degree fetal distress in labour could be predicted by the two experts.

DESIGN: Observational study.

SETTING: The maternity unit of Hammerfest Hospital, Norway.

POPULATION: Eight hundred and forty-five high and low risk women.

METHOD: The labour admission test was first assessed by the midwife or obstetrician in the clinical setting, and was later assessed by two experts. The traces were assessed as normal, equivocal or ominous. Weighted kappa (kappaw), proportion of agreement (Pa) and predictive values were calculated.

MAIN OUTCOME MEASURES: Weighted kappa, proportion of agreement, sensitivity, positive predictive value and likelihood ratios.

RESULTS: Inter-observer agreement between Expert 1 and Expert 2: kappaw 0.38 (CI 0.31-0.46), Pa for reactive labour admission test 0.86 (CI 0.83-0.88) and Pa for equivocal/ominous test 0.33 (CI 0.26-0.40). Agreement between Expert 1 and midwives/obstetricians: kappaw 0.25 (CI 0.15-0.36), Pa for reactive labour admission test 0.89 (CI 0.87-0.91) and Pa for equivocal/ominous labour admission test 0.18 (CI 0.11-0.25). Agreement between Expert 2 and midwives/obstetricians: kappaw 0.28 (CI 0.20-0.37), Pa for reactive labour admission test 0.85 (CI 0.82-0.88) and Pa for equivocal/ominous test 0.20 (CI 0.14-0.26). Totally 5.9% of the newborns had fetal distress. At cutoff equivocal test, sensitivity was 0.22 and 0.31 in the two observers. Positive predictive values were 0.13 and 0.11. Likelihood ratio for a positive test was 2.30 and 1.92 and likelihood ratio for a negative test 0.86 and 0.83.

CONCLUSION: A labour admission test is still routine practice in most obstetric units in the Western world when there is little evidence on its benefits. The results from this study may provide some reconsideration for such practice, and for more research.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:norden:org:diva-3389 (URN)12504927 (PubMedID)
Available from: 2014-09-17 Created: 2014-09-17 Last updated: 2017-12-05Bibliographically approved
5. Labor admission test: an assessment of the test's value as screening for fetal distress in labor.
Open this publication in new window or tab >>Labor admission test: an assessment of the test's value as screening for fetal distress in labor.
2001 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 80, no 8, 738-43 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: To determine if the labor admission test (LAT) can predict fetal distress in a population of laboring women, and in subgroups of low- or high-risk women, who delivered within six hours or between six and 24 hours after LAT.

METHODS: The data charts of all women who delivered at Hammerfest Hospital in 1996, 1997 and 1998 were retrospectively read. If the woman was admitted to the hospital because of onset of labor, was in the first stage of labor and delivered within 24 hours after admission, she was included. In the study period, 1639 gave birth and 932 were included in the study. A descriptive analysis of the population and assessment of LAT's sensitivity, positive predictive value, specificity and negative predictive value at different cut-off values was done.

RESULTS: In the study population 5.8% had fetal distress, and 5.3% had an operative delivery because of fetal distress. LAT's sensitivity in the whole population was 0.15 and positive predictive value was 0.16. Specificity was 0.95 and positive predictive value was 0.95. In the subgroups of low- and high-risk women, who delivered within six hours or between six and 24 hours after LAT, sensitivity varied between 0 and 0.36, and positive predictive value varied between 0 and 0.27. Specificity varied between 0.92 and 0.96, and negative predictive value varied between 0.89 and 0.97.

CONCLUSIONS: According to these results, LAT cannot be recommended as a screening test for fetal distress in labor in low-risk women. Sensitivity is too low, and there are too many false-positive tests. It is unclear if LAT has benefits among high-risk women.

Keyword
Electronic Fetal Monitoring, Fetal Distress, Labor Admission Test, Screening
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:norden:org:diva-3387 (URN)11531617 (PubMedID)
Available from: 2014-09-17 Created: 2014-09-17 Last updated: 2017-12-05Bibliographically approved

Open Access in DiVA

fulltext(1257 kB)457 downloads
File information
File name FULLTEXT01.pdfFile size 1257 kBChecksum SHA-512
dcfc49b06c51cdd1eed02f69d4195ccefc189cc2dcfcede5095e2526de44259fd3534152d7ff452c3e18864346bd622349e97b8f2837880dbfc5e9e5a56bd31f
Type fulltextMimetype application/pdf

By organisation
Nordic School of Public Health NHV
Medical and Health Sciences

Search outside of DiVA

GoogleGoogle Scholar
Total: 457 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

isbn
urn-nbn

Altmetric score

isbn
urn-nbn
Total: 130 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf