Intra- and interobserver variability of intrapartum cardiotocography: a multicenter study comparing the FIGO...

Area of Science:

• Obstetrics and Gynecology
• Fetal Monitoring
• Medical Informatics

Background:

• Intrapartum cardiotocograms (CTG) are crucial for fetal well-being monitoring.
• Subjective interpretation of CTGs, using systems like the FIGO classification, often shows significant inter- and intraobserver variability.
• This variability can potentially impact clinical decisions and patient outcomes.

Purpose of the Study:

• To compare the diagnostic accuracy and reliability of a computer analyzing software system against subjective interpretation using the FIGO classification for intrapartum cardiotocograms.
• To assess inter- and intraobserver agreement for both methods among obstetricians and midwives with varying experience levels.

Main Methods:

• Forty-three healthcare professionals (obstetricians and midwives) interpreted 12 cardiotocograms (CTG) readings.
• Interpretations were performed using both the FIGO classification and a computer analyzing software system.
• Inter- and intraobserver agreement were evaluated using proportions of agreement (Pa) for various CTG parameters.

Main Results:

• The FIGO classification showed very low agreement (Pa) for most parameters, with the lowest for accelerations.
• No significant differences in agreement were observed between obstetricians and midwives, or between junior and senior practitioners.
• Agreement was higher for normal CTG readings compared to pathological ones.

Conclusions:

• Computer analyzing software demonstrates potential in reducing the high inter- and intraobserver variability associated with subjective CTG interpretation.
• Further investigation is warranted to ascertain if this software can lead to improved fetal outcomes and a decreased rate of Cesarean sections.