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Inter-observer reliability of 4 fetal heart rate classifications
C Garabedian1, L Butruille2, E Drumez3
1University of Lille North of France, EA4489 Perinatal growth and environment, 59000 Lille, France; CHU Lille, Jeanne de Flandre Hospital, Department of obstetrics, 59000 Lille, France.
Journal of Gynecology Obstetrics and Human Reproduction
|April 14, 2017
Summary
Inter-observer agreement for fetal heart rate (FHR) interpretation is moderate across all classifications. Further research is needed to compare the impact of different FHR classification systems on neonatal outcomes.
Area of Science:
- Obstetrics and Gynecology
- Fetal Monitoring
- Perinatal Medicine
Background:
- Multiple fetal heart rate (FHR) classification systems exist, including 2-tier, NICHD 3-tier (2008), CNGOF 5-tier (2013), and FIGO 3-tier (2015).
- Assessing the reliability of these systems is crucial for consistent clinical interpretation.
Purpose of the Study:
- To evaluate and compare the inter-observer reliability of four distinct fetal heart rate (FHR) classification systems.
- To determine the consistency of FHR pattern interpretation among different obstetric professionals.
Main Methods:
- Four independent observers reviewed 100 FHR tracings from term singleton pregnancies.
- FHR patterns were classified using a 2-tier, NICHD 2008, CNGOF 2013, and FIGO 2015 system.
- Inter-observer agreement was quantified using kappa statistics.
Main Results:
- Moderate global agreement was observed for all classifications: 2-tier (0.58), NICHD 2008 (0.48), CNGOF 2013 (0.58), and FIGO 2015 (0.59).
- High concordance was found between the FIGO category I and "reassuring" FHR classifications (kappa=0.95).
- Discrepancies in classifying reassuring FHRs were noted, particularly with the CNGOF 2013 system.
Conclusions:
- Inter-observer agreement in FHR interpretation remains moderate regardless of the classification system employed.
- Further studies are warranted to compare the clinical utility and impact of these FHR classifications on interventions and neonatal outcomes.