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Evaluation of interobserver agreement of cardiotocograms
J Bernardes1, A Costa-Pereira, D Ayres-de-Campos
1Departamento de Ginecologia e Obstetrícia, Hospital de S. João, Faculdade de Medicina do Porto, Oporto, Portugal.
Insights
Interobserver agreement for cardiotocographic events is poor, even with FIGO guidelines. This impacts the reliability of fetal heart rate monitoring analysis.
Area of Science:
- Perinatal medicine
- Obstetrics
- Fetal monitoring
Background:
- Cardiotocography (CTG) is a standard tool for fetal surveillance.
- Interobserver variability in CTG interpretation can affect clinical decisions.
Purpose of the Study:
- To assess the interobserver agreement among experts in analyzing cardiotocographic events.
- To evaluate the reproducibility of CTG interpretation based on FIGO guidelines.
Main Methods:
- Three experts independently analyzed antepartum and intrapartum CTGs.
- Events were classified according to FIGO guidelines: baseline segments, accelerations, decelerations, and uterine activity.
- Agreement was quantified using proportions of agreement (pa).
Main Results:
- Acceptable reproducibility was found for baseline segments with normal variability, accelerations, and uterine activity (pa = 0.56-0.71).
- Poor reproducibility was observed for other CTG segments (pa = 0.14-0.45).
Conclusions:
- Visual analysis of most cardiotocographic events shows poor reproducibility, even when using FIGO guidelines.
- Ambiguous guidelines, limitations in visual assessment, and clinician capacity may contribute to this variability.
Objective:
To evaluate interobserver agreement in visual analysis of each cardiotocographic event.
Methods:
Three experts independently divided 16 antepartum and 17 intrapartum cardiotocograms into baseline segments, accelerations and decelerations, according to the FIGO guidelines. Baseline segments were further classified as having normal, reduced or increased variability and decelerations as early, late and variable. Uterine activity was divided into tonus and contractions. Agreement was assessed by the proportions of agreement (pa) with 95% confidence intervals.
Results:
Reproducibility in assessment of baseline segments with normal variability, accelerations and uterine activity was acceptable (pa = 0.56-0.71) whereas that of other segments was not (pa = 0.14-0.45).
Conclusions:
Analysis of most cardiotocographic events is poorly reproducible, even when experts use the FIGO guidelines. This may be explained by some still ambiguous guidelines, by eyeball limitations in evaluation of subtle events, and by the incapacity of busy clinicians to assess complex and multiple cardiotocographic events in a systematic and disciplined fashion.