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Introduction <p>Antenatal detection of structural fetal anomalies is rising with advancements in prenatal imaging, necessitating robust frameworks for risk stratification and counseling. Traditional binary approaches often fail to encompass the multifactorial decision-making process involved. To address this gap, the MORE classification system—encompassing Management (M), Outcome (O), Risk (R), and Expectation (E)—was developed to guide structured antenatal counseling.</p> Methods <p>This prospective study evaluated the inter-rater reliability and construct validity of the MORE classification when applied independently by three senior pediatric surgeons to 55 antenatally diagnosed fetal anomalies. Ratings were performed using the M, O, and R components, with E excluded from statistical analysis due to its subjectivity. Intraclass correlation coefficients (ICC), Fleiss’ kappa, Cronbach’s alpha, and Spearman’s correlation were computed.</p> Results <p>The study cohort had a median gestational age of 19 weeks, with 42% primigravidas. Isolated anomalies were predominant (80%), and 16.4% had suspected chromosomal associations. Internal consistency was acceptable to good (Cronbach’s α: 0.757–0.812), and construct validity was high (Spearman’s ρ overall = 0.812). ICCs indicated fair-to-moderate inter-rater agreement (0.398–0.584). Fleiss’ kappa showed variable agreement: slight for Management (<i>κ</i> = 0.163), fair for Outcome (<i>κ</i> = 0.293), and moderate for Rsk (<i>κ</i> = 0.409). Test–retest reliability was excellent across all domains.</p> Conclusion <p>The MORE classification demonstrated good reliability and strong validity in antenatal counseling when used by experienced pediatric surgeons. While the Outcome domain showed highest consistency, the Management and Risk domains warrant refinement for broader adoption. The classification provides a pragmatic, structured framework for multidisciplinary decision-making and can aid in standardizing antenatal counseling practices, especially in resource-limited settings.</p>

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Management, Outcome, Risk, and Expectation classification for structural fetal anomalies to aid antenatal counseling: a prospective validation study

  • 期刊论文

  • 发表日期：

    2025年10月8日

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  • Vikesh Agrawal,
  • Ramesh Babu,
  • Kanishka Das,
  • Arvind Sinha,
  • Lakshmi Sundararajan,
  • Prabudh Goel,
  • Rekha Agrawal

摘要

Introduction

Antenatal detection of structural fetal anomalies is rising with advancements in prenatal imaging, necessitating robust frameworks for risk stratification and counseling. Traditional binary approaches often fail to encompass the multifactorial decision-making process involved. To address this gap, the MORE classification system—encompassing Management (M), Outcome (O), Risk (R), and Expectation (E)—was developed to guide structured antenatal counseling.

Methods

This prospective study evaluated the inter-rater reliability and construct validity of the MORE classification when applied independently by three senior pediatric surgeons to 55 antenatally diagnosed fetal anomalies. Ratings were performed using the M, O, and R components, with E excluded from statistical analysis due to its subjectivity. Intraclass correlation coefficients (ICC), Fleiss’ kappa, Cronbach’s alpha, and Spearman’s correlation were computed.

Results

The study cohort had a median gestational age of 19 weeks, with 42% primigravidas. Isolated anomalies were predominant (80%), and 16.4% had suspected chromosomal associations. Internal consistency was acceptable to good (Cronbach’s α: 0.757–0.812), and construct validity was high (Spearman’s ρ overall = 0.812). ICCs indicated fair-to-moderate inter-rater agreement (0.398–0.584). Fleiss’ kappa showed variable agreement: slight for Management (κ = 0.163), fair for Outcome (κ = 0.293), and moderate for Rsk (κ = 0.409). Test–retest reliability was excellent across all domains.

Conclusion

The MORE classification demonstrated good reliability and strong validity in antenatal counseling when used by experienced pediatric surgeons. While the Outcome domain showed highest consistency, the Management and Risk domains warrant refinement for broader adoption. The classification provides a pragmatic, structured framework for multidisciplinary decision-making and can aid in standardizing antenatal counseling practices, especially in resource-limited settings.