Guideline choice for CTG analysis influences first caesarean decision

Area of Science:

• Obstetrics and Gynecology
• Fetal Monitoring
• Surgical Decision-Making

Background:

• First caesarean sections (CS) for non-reassuring intrapartum cardiotocography (CTG) are common.
• Standardized analysis of CTG is crucial for appropriate surgical intervention.

Purpose of the Study:

• To compare the reproducibility of intrapartum CTG analysis between FIGO and CNGOF guidelines for first CS.
• To assess the impact of obstetrical context on the justification of CS based on CTG findings.

Main Methods:

• Retrospective analysis of 100 first CS cases due to non-reassuring CTG by four obstetricians.
• CTG interpretation using FIGO and CNGOF guidelines, with and without obstetrical context.
• Evaluation of inter-observer agreement and justification of CS.

Main Results:

• FIGO guidelines showed significantly higher inter-observer concordance (kappa=0.331) than CNGOF guidelines (kappa=0.209).
• Considering obstetrical context reduced the rate of unjustified CS from 70% to 16%.
• A significant proportion of unjustified CS occurred during night hours.

Conclusions:

• FIGO guidelines offer superior reproducibility for CTG analysis in the context of first CS.
• Inter-observer agreement, while low, was fair and improved with FIGO guidelines.
• Guideline selection and inclusion of obstetrical context are critical for informed CS decisions.