A study was presented by Susana Pereira at the BIRTH congress introducing Fast and frugal trees to simplify triage of women for monitoring with ST analysis. The study shows substantial agreement among experts in CTG monitoring when using the tree. Frontline users also find the tree easy to use in real clinical settings.
Susana Pereira, a leading obstetrician and NHS consultant in obstetrics and maternal fetal medicine in the UK, presented a new study at the BIRTH congress in Milan on 9 December, 2022, introducing Fast and frugal trees, a new decision-making tool for use in obstetric settings. The study is titled: Is the fetus fit for labour? Introducing fast and frugal trees to simplify triage of women for Stan monitoring, and is authored by Susana Pereira, Petra Bakker, Ahmed Zaima and David Wertheim.
The trees have been developed to aid a physiology-based interpretation of CTG. The purpose of the study was to investigate whether the Fast and frugal tree could be used to simplify triage of women for monitoring with ST analysis. The study assessed the inter-observer agreement when the tree was used by experts as well as usability in real clinical settings through a staff survey conducted in a large maternity hospital.
Thirty-six challenging cases were selected from a European multicenter study database. Eight European experts in CTG and ST analysis were invited to assess the CTG traces and apply the Fast and frugal tree. The tree poses a number of yes-or-no questions related to fetal heart rate, time spent on baseline and variability on the CTG trace. If all questions had a positive answer the tree would propose proceeding with ST analysis; if any of the questions had a negative answer, the proposed action would instead be to intervene, reduce hypoxic stress, consider infection or to deliver.
The staff survey was conducted at Kingston Hospital in the UK, a large maternity hospital with 5,000 deliveries per year. Both midwives and doctors were invited to the survey, which had 46 respondents. Seventy-nine percent agreed or strongly agreed that the Fast and frugal tree was easy to use, and 85% said they agreed or strongly agreed that the tree was logical, safe and consistent with CTG training.
The study concludes that the Fast and frugal tree simplifies triage of women for monitoring with ST analysis, making it clearer for which patients ST analysis in labour is appropriate, and when other measures should be taken. There was substantial inter-observer agreement when the tree was used by CTG experts in 36 challenging cases. In addition, frontline users found the tool logical and easy to use in real clinical life.
The fast and frugal trees are part of the new physiological guidelines for CTG and ST analysis. For more information contact info@neoventa.com
