The Agreement of Readability and Interpretability of Fetal Heart Rate Between Mobile and Conventional...

Background/Objective: Conventional cardiotocography (CTG) is an essential tool for fetal surveillance but remains inaccessible in many low-resource settings. Emerging low-cost, wireless mobile CTG systems designed for home-based use may enhance global access to fetal monitoring. Nevertheless, their concordance with conventional CTG in the interpretation of FHR patterns remains insufficiently validated. This study aimed to evaluate agreement in the readability and interpretability of FHR baseline patterns and accelerations/decelerations between mobile and conventional CTG. Methods: A prospective study was conducted in pregnant women undergoing antepartum surveillance to evaluate agreement in the interpretation of FHR tracings simultaneously obtained from mobile and conventional CTG. Each paired tracing was independently and blindly assessed by two physician reviewer groups. Results: A total of 404 women underwent simultaneous assessment with both modalities. Agreement in baseline FHR interpretation was excellent between reviewer groups and modalities (ICC > 0.95). Interpretation of accelerations and decelerations also demonstrated very good agreement (κ = 0.8-0.9), whereas agreement for FHR variability and uterine contractions was moderate. Both reviewer groups assigned slightly but significantly higher quality scores and satisfaction scores to conventional CTG compared with mobile CTG. Conclusions: Mobile CTG demonstrates excellent agreement with conventional CTG in the assessment of FHR baseline and accelerations/decelerations. However, the overall quality and user satisfaction associated with mobile CTG were slightly lower than those observed with conventional CTG. Because of its advantages, including lower cost, portability, and user-friendly design, mobile CTG may serve as a feasible alternative for antepartum surveillance in low-resource settings worldwide.