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Analysis of antepartum fetal heart rate tracing by physician and computer
L A Bracero1, D Roshanfekr, D W Byrne
1Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, New York, USA.
Insights
Physician interpretation of fetal heart rate (FHR) tracings showed poor agreement among themselves and with computer analysis. A scoring system did not improve physician consensus on FHR assessment for high-risk pregnancies.
Area of Science:
- Obstetrics and Gynecology
- Perinatal Medicine
- Medical Informatics
Background:
- Fetal heart rate (FHR) monitoring is crucial for assessing fetal well-being during pregnancy.
- Interpretation of FHR tracings can be subjective, leading to variability in clinical decisions.
- Computerized analysis offers a potential objective method for FHR interpretation.
Purpose of the Study:
- To compare the interpretation of antepartum FHR tracings by three obstetricians with a computer analysis program.
- To evaluate the effectiveness of a modified FHR scoring system in improving inter-physician agreement.
Main Methods:
- 121 antepartum FHR tracings from 54 high-risk pregnant women were analyzed.
- Three physicians and a computer program (Oxford Sonicaid System 8000) interpreted the tracings.
- Physicians used a scoring system (0-10); computer used overall variation (ms).
Main Results:
- Significant differences were observed in the interpretation of individual FHR elements among physicians and between physicians and the computer.
- Inter-physician agreement was poor (kappa: -0.037 to 0.28) when using the scoring system.
- The computer identified two tracings as questionable, while all physicians classified them as normal.
Conclusions:
- There is poor agreement in FHR tracing interpretation among physicians and between physicians and computer analysis.
- A standardized FHR scoring system did not enhance the consistency of interpretation among obstetricians.
- Further research is needed to improve the reliability of FHR interpretation methods.
Objective:
To compare the interpretation of fetal heart rate (FHR) tracings by three obstetricians with that of a computer analysis program.
Methods:
Our study population consisted of high-risk pregnant women referred as outpatients for antepartum FHR monitoring. A total of 121 FHR tracings, from a series of 54 consecutive women, were interpreted by three physicians and a computer program (Oxford Sonicaid System 8000, Oxford Sonicaid Ltd., Chichester, UK). The physicians used a modified FHR scoring system to interpret the tracings. Total scores were categorized as 0-4: abnormal, 5-7: questionable, and 8-10: normal. The computer program used overall variation, categorized as normal: longer than 30 ms, abnormal: shorter than 20 ms, and questionable: 20-30 ms.
Results:
Significant differences were found among the physicians and between the physicians and the computer analysis for the individual elements of FHR tracings. There was very good agreement between two physicians and the computer in the assessment of the FHR baseline. When physicians used a FHR scoring system to classify the tracings as normal, questionable, or abnormal, the agreement was poor (kappa values ranged from -0.037 to 0.28). The computerized analysis identified two FHR tracings as questionable but both were classified as normal by all three physicians.
Conclusions:
The level of agreement in the interpretation of FHR tracings was poor among physicians and between physicians and the computer analysis. A FHR scoring system did not improve the level of agreement between physicians.