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Computerised cardiotocography in a high-risk unit in a developing country--its influence on inter-observer variation
1Department of Obstetrics and Gynaecology, Tygerberg Hospital, W. Cape.
Objective:
To determine the role of computer-assisted cardiotocography in an obstetric special care unit and its influence on inter-observer variation in interpretation, proposed management and monitoring time.
Design:
A prospective comparative study.
Setting:
The obstetric special care unit, Tygerberg Hospital, W. Cape.
Study Population:
A group of 10 registrars in obstetrics who have had experience in the interpretation of both standard and computer-assisted cardiotocographs.
Main Outcome Measures:
The influence of method of cardiotocograph recording on inter-observer variation in respect of suggested management of the patient, as well as the observer's opinion of the duration of the recording.
Results:
Variation in suggested management decreased significantly after assessment of the computer reports, compared with the standard cardiotocographs. While delivery was regarded to be indicated in 3.5% of patients and an immediate repeat of the cardiotocograph in a further 10%, no such action was proposed after evaluation of the computer reports of the same recordings. Thirty-four per cent of tracings were considered to have been too long and 12.5% too short. However, suggested management in 40% of the latter cases seemed inappropriate for tracings regarded as of too short a duration.
Conclusion:
While computer-assisted cardiotocographs significantly decrease inter-observer variation in the proposed management of patients, its cost-effectiveness in an obstetric special care unit in a developing country should be validated, as it might increase monitoring time.