Interobserver variation in the assessment of fetal heart rate recordings

Electronic fetal heart rate monitoring (EFM) has not fulfilled its expectations. To improve its validity various attempts were made to standardize terminology and assessment of fetal heart rate (FHR) recordings. In a multinational study, 21 experienced obstetricians were asked to segment and classify FHR patterns, recorded in 13 obstetric cases. In addition, the referees were asked to give their interpretation of the FHR pattern, to assess the fetal condition and to propose obstetric management. The kappa statistic showed fair agreement among the obstetricians for the classification of accelerations, baseline segments and decelerations. Poor agreement was found when the referees had to classify baseline variability or the type of deceleration. Also, the clinical assessment of fetal condition and proposals for obstetric management showed poor agreement among the referees. We conclude there is still a lack of unequivocal terminology and definitions in the assessment of FHR recordings.