Intrapartum cardiotocography: an exploratory analysis of interpretational variation

Area of Science:

• Obstetrics and Gynecology
• Fetal Monitoring
• Clinical Interpretation

Background:

• Intrapartum cardiotocography (CTG) interpretation is subjective, leading to variability in agreement among healthcare professionals.
• Existing guidelines, such as the 2015 FIGO classification, aim to standardize CTG analysis but challenges in inter- and intra-observer agreement persist, particularly for abnormal findings.

Purpose of the Study:

• To assess intra- and inter-operator agreement in cardiotocography (CTG) trace analysis using the 2015 FIGO classification.
• To investigate the influence of educational background and anamnestic data on CTG interpretation by obstetricians and midwives.

Main Methods:

• A retrospective analysis of 73 intrapartum CTG traces was conducted by eight operators (four obstetricians, four midwives) at two time points.
• Interpretations were performed blindly at T0 and with additional anamnestic pregnancy information at T1, two months later.
• Intra- and inter-observer agreement rates were calculated and compared between professional groups.

Main Results:

• Midwives demonstrated higher intra-observer agreement (77.05%) compared to obstetricians (65.75%).
• Moderate inter-observer agreement was found for classifying CTG traces as 'normal'.
• No consensus was reached for classifying CTG traces as 'suspect' or 'pathological', with anamnestic data influencing obstetricians' interpretations more than midwives'.

Conclusions:

• Anamnestic data significantly influence the interpretation of suspicious and pathological CTG traces, particularly for obstetricians.
• Enhanced cooperation between obstetricians and midwives is recommended to optimize CTG reading and improve maternal and neonatal outcomes.
• Further research should focus on identifying specific clinical parameters that correlate with increased risk of fetal distress and adverse neonatal outcomes to improve blind CTG interpretation skills.