Fetal heart rate tracings: observers versus computer assessment.
Cardiotocography (CTG) is widely used despite the fact that its diagnostic accuracy is far from satisfying. This is due, among other reasons, to the great intra- and interobserver variation in reading the fetal heart rate tracings. Computerized analysis might be a means to overcome the latter problem.


OBJECTIVE
the present study was designed to assess the reproducibility of CTG readings among observers and between observers and a computer system.


METHODS
63 fetal heart rate tracings were read by 4 clinicians (2 experienced and 2 inexperienced) and by the 2CTG computerized system. The variables considered were: baseline fetal heart rate (FHR), long-term variability (amplitude bandwidth around the baseline), number of large accelerations and number and type of decelerations.


RESULTS
the agreement among observers, assessed by means of kappa coefficient, ranges from fair to good. The agreement between each of the observers and the computer readings, ranges from 0.18 to 0.48 for FHR baseline, from 0.16 to 0.74 for variability, from 0.37 to 0.64 for the number of accelerations and from 0.41 to 0.54 for the number of decelerations. The agreement on the type of decelerations is very low (0.01-0.25).


CONCLUSIONS
it is concluded that interobserver variability between experienced observers, inexperienced observers and 2CTG is considerable and that the use of a computer system should overcome this problem.
Todros
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Dipartimento di Discipline Ginecologiche e Ostetriche, Via Ventimiglia 3, 10126 Torino, Italy. TODROS@IOL.IT
Preve
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Plazzotta
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Biolcati
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Lombardo
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D015148:Cardiotocography / Q000379:methods* / Q000706:statistics & numerical data; D003201:Computers; D005260:Female; D006340:Heart Rate, Fetal; D006801:Humans; D015588:Observer Variation; D011247:Pregnancy; D015203:Reproducibility of Results